Improving Disparities

Couple examines issues in Memphis to ‘move the needle’

By Don Wade

Working to better understand, and thus bring down, Shelby County’s infant mortality rate would be a giant undertaking.

Paul D. Juarez, left, and Patricia Matthews-Juarez came to Memphis less than a year ago to set up the Research Center on Health Disparities, Equity and the Exposome.

(Daily News/Andrew J. Breig)

But that is but one of many challenges that lie ahead of a husband-and-wife team of doctors who nine months ago moved from Nashville to Memphis to set up the Research Center on Health Disparities, Equity and the Exposome.

Paul D. Juarez, Ph.D, and Patricia Matthews-Juarez, Ph.D, were recruited by Dr. David Stern, executive dean of the College of Medicine at the University of Tennessee Health Science Center to not only document, research and examine health disparities here, but as Stern told them, to “move the needle.”

A tough city that the couple says it loves. They live Downtown. And they are known well enough in their neighborhood that if Juarez is walking alone, any number of homeless people might ask him, “Where’s the missus?”

From the outside looking in, one might imagine that they have signed up for the medical research version of Mission: Impossible. Consider that while the United States’ infant mortality rate was 6.05 per 1,000 live births in 2011, according to the Centers for Disease Control, Shelby County’s infant mortality rate for 2012 was 10.6 deaths per 1,000 live births.

But it’s not just infant mortality that is a huge issue. Matthews-Juarez says that as far back as 1988, there was evidence that African-American women with breast cancer died at a rate of 2-to-1 compared to white women. That hasn’t changed.

The study of health disparities is complicated, but on the ground it can perhaps somewhat be explained by the either-or choices that, say, a poor, sick, single mother living in an area with no nearby primary care physician might face.

“If she has to make a choice between putting food on the table and going to a doctor across town, she’s going to choose food on the table,” Matthews-Juarez said

Added Juarez: “Transportation is a major issue. If they can’t get to the doctor (early), then they end up in the emergency room, they find a lump (in the case of breast cancer), and it’s too late.”

Disparities, he says, come about for many reasons and often can be traced back to differences in income, race, social and other factors. Outcomes include morbidity, mortality, life expectancy, conditions and behaviors.

The word “exposome” refers to a measurement of environmental impact on a person’s health throughout their lifetime.

“I view the most pressing problem in Memphis medicine to be caring for the underserved African-American population in the Downtown area,” Stern said. “This group has an excessive burden of disease – from many perspectives across the life cycle.”

In the case of the health disparity center established here, the “exposome” model will focus on several things: the natural environment, which includes the air, water and land; the man-made environment, which includes transportation, buildings and community resources; the social environment, which includes poverty, education and racial segregation; and the policy environment, which includes federal, state and local laws.

The challenges in these areas, in most cases, are neither new nor capable of being solved by money alone or in a short amount of time.

“You can’t write grants to get out of the disparity problem in Memphis,” Matthews-Juarez said. “It’s too old.”

Grants help, of course, but cooperation is a key factor as they reach out across every imaginable part of the community – from government to medical to community organizations.

“Part of it is people have got to move beyond their own organizations,” Juarez said.

The couple will be gathering and measuring data on health disparities in several categories: cancers; cardio-metabolic diseases, including diabetes; cardiovascular disease and obesity; HIV and sexually transmitted diseases; maternal and child health, including infant mortality, low birth weight and preterm labor; intentional and unintentional injuries, which include things such as domestic violence and motor vehicle accidents; and mental health and substance abuse, which includes depression and suicide.

They also are collaborating with the CANDLE study, which for eight years has followed pregnant women to identify which factors during pregnancy and a child’s early life have an impact on development and learning capabilities.

Matthews-Juarez calls all this information that they are gathering and studying “large data.” But she makes clear that is not where their work ends, merely where it begins.

“I’m not in the business of doing research for research’s sake,” she said. “It’s a long-term commitment, but we’re committed.”